What is a Calendar Year Deductible?
Some covered benefits may have a separate calendar year deductible. One benefit that commonly has a separate deductible is brand name prescription drugs. When a benefit has a separate calendar year deductible, the plan’s deductible does not additionally apply to the benefit. Basically, the calendar year deductible tells you how much each year you will be responsible for paying toward your covered medical expenses before the insurance company begins paying their share. Some insurers offer a calendar year deductible “roll-over” option, which allows any amounts paid toward the deductible at the end of the year to apply toward the following year, if the deductible was not met in that year. The length of time for this roll-over benefit may vary from those insurance companies that offer this. Some may roll-over the last month, while other may roll-over the last quarter. 2 CommentsLeave a comment |
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What is a Calendar Year Deductible?
When shopping for a health plan, you will commonly see reference to the plan’s calendar year deductible. Anytime a deductible is referred to as “calendar year,” this indicates that the deductible begins on January 1st and ends on December 31st of each year. As we have described throughout this website, a deductible is the amount that must be paid by the insured member before they start receiving benefits from the insurance company. Review your plan details closely to determine which services apply to the calendar year deductible and which do not. Those services that do not apply to the calendar year deductible should clearly state “deductible waived” or some other verbiage that makes it clear you are receiving first dollar benefits for this service. HMO plans have historically required no calendar deductible, but HMO plans with deductibles for certain covered benefits, such as hospitalization, are becoming the standard. All PPO plans today require a calendar deductible.
I am currently applying for health insurance with Aetna Health Insurance and I have no problems filling out the forms, except for one little thing. On the attached sheet it says that for doctors office it is “subject to calendar-year deductible”. What does that mean? I have a deductible for $10,000 on the plan. Does that mean I will have to pay $10,000 for doctors visits before Aetna Health Insurance starts paying? That seems awfully high. Could it be referring to another deductible? Or could it be that the $10,000 is referring to the maximum amount I can get for doctors visits over the course of the year?
I have asked some friends and they all think that this must be some kind of catastrophic only health insurance since the deductible is that high.
Comment by Brian — May 27, 2009 @ 12:07 pm
Yes Brian, you do have a catastrophic policy, designed to protect you primarily from major medical expenses. Your offices visits will not be covered until you meet the deductible, and you may still have a coinsuramce on top of that.
Comment by admin — May 27, 2009 @ 6:29 pm